慢性静脉疾病的双功超声扫描：静脉反流模式

Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux.

作者信息

Myers K A, Ziegenbein R W, Zeng G H, Matthews P G

机构信息

Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Australia.

出版信息

J Vasc Surg. 1995 Apr;21(4):605-12. doi: 10.1016/s0741-5214(95)70192-3.

DOI:10.1016/s0741-5214(95)70192-3

PMID:7707565

Abstract

PURPOSE

Patterns of flow in superficial and deep veins and outward flow in medial calf perforators were studied by duplex ultrasonography scanning in 1653 lower limbs in 1114 consecutive patients. This study compares results in 776 limbs with primary uncomplicated varicose veins with those in 166 limbs with the complications of lipodermatosclerosis or past venous ulceration.

METHODS

Duplex scanning determined whether superficial and deep veins were occluded or showed reflux and whether outward flow occurred in medial calf perforators with calf muscle contraction.

RESULTS

Two proximal deep veins were occluded. When limbs with primary uncomplicated varicose veins, lipodermatosclerosis, or past ulceration were compared, superficial reflux alone was seen in 55%, 39%, and 38%, deep reflux alone was seen in 2%, 7%, and 8%, and combined superficial and deep reflux was seen in 18%, 34%, and 48%, respectively. Superficial reflux affected the long saphenous system alone in 58%, 57%, and 40%, the short saphenous system alone in 18%, 18%, and 26%, and both the long and short saphenous systems in 24%, 25%, and 34%, respectively. Limbs with ulceration more frequently showed superficial reflux (p < 0.05), and all limbs with complications more frequently showed short saphenous reflux (p < 0.05) and deep reflux (p < 0.01) specifically in the posterior tibial veins (p < 0.01). Outward flow was seen in medial calf perforators in 57%, 67%, and 66%, respectively; it occurred more frequently in all limbs with complications (p < 0.05). Isolated outward flow in perforators without superficial or deep reflux was seen in 10%, 10%, and 2%, respectively.

CONCLUSIONS

Most limbs with complications had superficial reflux either alone or combined with deep reflux, and few had deep reflux alone. Reflux was more frequent in posterior tibial veins for limbs with complications compared with those with uncomplicated primary varicose veins. Outward flow in perforators was common in limbs with complications and with uncomplicated primary varicose veins, but isolated outward flow in perforators was uncommon. Treatment directed to the superficial veins alone may be sufficient for most patients with complications.

摘要

目的

通过对1114例连续患者的1653条下肢进行双功超声扫描，研究浅静脉和深静脉的血流模式以及小腿内侧穿支静脉的外向血流。本研究比较了776条原发性单纯性静脉曲张下肢与166条伴有脂肪硬化或既往静脉溃疡并发症的下肢的结果。

方法

双功扫描确定浅静脉和深静脉是否闭塞或存在反流，以及小腿肌肉收缩时小腿内侧穿支静脉是否有外向血流。

结果

两条近端深静脉闭塞。比较原发性单纯性静脉曲张、脂肪硬化或既往溃疡的下肢时，单纯浅静脉反流分别见于55%、39%和38%，单纯深静脉反流分别见于2%、7%和8%，浅静脉和深静脉联合反流分别见于18%、34%和48%。浅静脉反流仅影响大隐静脉系统的分别为58%、57%和40%，仅影响小隐静脉系统的分别为18%、18%和26%，同时影响大隐静脉和小隐静脉系统的分别为24%、25%和34%。有溃疡的下肢更常出现浅静脉反流（p<0.05），所有有并发症的下肢更常出现小隐静脉反流（p<0.05）和深静脉反流（p<0.01），特别是在胫后静脉（p<0.01）。小腿内侧穿支静脉出现外向血流的分别为57%、67%和66%；在所有有并发症的下肢中更常见（p<0.05）。穿支静脉孤立的外向血流，无浅静脉或深静脉反流的分别见于10%、10%和2%。

结论

大多数有并发症的下肢单独或合并深静脉反流出现浅静脉反流，单独出现深静脉反流的很少。与原发性单纯性静脉曲张的下肢相比，有并发症的下肢胫后静脉反流更常见。穿支静脉的外向血流在有并发症和原发性单纯性静脉曲张的下肢中都很常见，但穿支静脉孤立的外向血流不常见。对于大多数有并发症的患者，仅针对浅静脉的治疗可能就足够了。